Therapy for Me Equals N3

Date :

January 30, 2024

My favorite episode of Sandman, a Netflix adaptation of the Neil Gaiman’s graphic novel, centers around a deal Dream (the Sandman) makes with a man who claims to want immortality. Dream is a deity who delivers slumber to humans. While visiting a tavern in England in the year 1200, he overhears a pub goer’s claim and grants him immortality with the condition that he return to this site every century. As centuries pass we see this man grow and change along with the world around him. It’s a beautiful reminder of the impermanence of life and how experience influences knowledge, which can change our perspective so that we grow. 

I love this because I believe that knowledge isn’t fixed, our understanding of the world and ourselves is constantly evolving because our consciousness expands with experience and by learning stuff. Personal philosophies should always be open to change, too. Mine is certainly a work in progress. This post will focus on my philosophy in action as a clinician, and I’m writing it here for my benefit, as it helps to clarify it for myself, as well as for the benefit of those with whom I work. Currently, I see my work through three lenses: Narrative, Neuroscience, and Nature (N3). My practice exists within the space where these areas overlap. 

Before diving into these sections, I want to address why I’ve picked neuroscience and not psychology or some modality like Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach (CBT) and a powerful, useful intervention. Neuroscience is the conceptual lens that helps me understand why ACT works. I like neuroscience because it’s multidisciplinary and elicits what E.O. Wilson termed consilience, an expansive way to seeing connections between different studies. It demonstrates how narratives are an innate cognitive process and connection point to others. It explains why nature is important for mental health, primarily through a concept called body balance. 

It also speaks to something I read in Rick Rubin’s book, The Creative Act: A Way of Being (this book isn’t just for artists; its meditations aid any discipline). He shares the story of how AI bested Go, a Chinese game that humans have tried to master for centuries. AI won, he realized, not because it was smarter; it was acting as a beginner, following “no fixed rules, not the millennia of accepted cultural norms attached to them.” That’s the art of being a beginner, and that’s how I like to show up. 


I also show up because I love hearing people’s stories. I’ve always loved stories. I studied English literature. I spend copious hours on television, movies, and novels. I’ve made a living as a writer for nearly 15 years. It’s also why I became a therapist: I enjoy listening to and exploring other people’s stories, and not so I can write about them; I genuinely enjoy connecting with folks. 

Stories are beautiful and telling them is innately human. Stories transcend time and cultures. Joseph Campbell’s concepts of the hero’s journey and the power of myth show that there are inherent structures and archetypes characteristic of all cultures across time. This resonates, and not in a reductive way. The underlying structure, theme, and symbols correspond with the various stages of life, the encounters we have in our relationships, the pains we endure, and the mystery of being. These stories often correspond with rites of passage that have been, as Guy Ritchie noted, “robbed” from us by the homogenization of pop culture of today, leaving us without the necessary guideposts and collective narratives constructed to assuage our angst and longings for connection to others; stories fill that sense of isolation with the comfort of knowing that we are not alone. 

Now, I’m not advocating that cultures be appropriated for common use. Rather, the fact that there is an immutable commonality of structure and character-type speaks to me on a spiritual level, as if to say, we are connected, we have something to share that will resonate because its structural framework is universal where language is not. In a fracturing world, why wouldn’t we rely on this shared aspect of our cognition and humanity? 

Of course, meaning isn’t necessarily universal, which is something I’ll get to in the neuroscience section. Not every culture experiences emotions like grief in the same way, which is why stories are the gateway towards connection and understanding. If your salt mine is marketing or politics you know that facts don’t matter half as much as the story and the person telling it. 

Cultural stories play on how we construct our sense of self and identity. Being a woman in 1824 meant something much different than being a woman in 2024. Cultures and their narratives change and this influences how we tell our story. But the general cycles of childhood to adolescence to adulthood to death don’t change. The thresholds we cross still come with costs, trials and tribulations, and rewards and punishments. 

Thinking about stories as a writer isn’t much different than thinking about stories as a clinician. Both can be deconstructed, analyzed by their culture, perspective, place in history, and experience. Stories can also be reauthored to be of greater use. Stories can have lessons that let us proceed with greater knowledge and the ability to overcome obstacles. Stories involve change and speak to our capacity to adapt, which is critical to neuroscience. 


What makes a story? Naturally there’s a beginning, middle and end, but many events have those components. Stories gain salience from what psychologist Lev Vygotsky defined as “the violation of expectation.” Dramatist David Mamet named a similar dynamic, the element of surprise. Hollywood is littered with predictable stories, but the ones that we love surprise us. Mamet notes this as the punchline of the joke, where the expectation of an outcome is subverted. 

Take that Sandman episode: Man is mortal and eventually dies; Sandman grants an exception; man lives for hundreds of years and has realizations. All great stories subvert expectation via a realization. Every day you thought X, then Y happened and you then realized Z. 

It makes me think of Attachment Theory, the idea that our early relationship with our parents defines how we relate to others as we age. In a securely attached relationship: Mom takes care of me as expected; I feel safe; I grow up to have healthy relationships. Biologically that’s how things are meant to work. 

Let’s consider the alternative. Mom is caregiver and supposed to take care of me; mom is absent and cold; my needs aren’t met; I struggle to regulate within the environment and develop maladaptive coping mechanisms. 

To be fair to the parent, consider that they could’ve been overwhelmed or distracted or dealing with their own developmental story. The child sees the world simply and is wired to rely on the caregiver for security. If the caregiver falls short, then the child creates a simple narrative to make sense of this, and this narrative is self-protecting because the caregiver is innately perceived to be the strong one, so the notion that the caregiver is falling short would rupture the child’s ego and stability. This often shows up in Cognitive Theory as the negative core belief, which could sound like: I'm unlovable; I'm worthless.

Any parent with more than one kid knows that no two kids are alike, despite all things appearing equal. Personality aspects, like temperament and openness, which are largely inherent (but which can be altered later), may impact how we respond to the outside world. Plus, children haven’t fully developed all the cognitive abilities to reason. This is where neuroscience comes into play. Vygotsky noted that we have an internal dialogue — the ole voice in our noggin — which is relational and internalized. This voice is also influenced by culture, history, and experience, all of which feed the context that colors our understanding. Dan Siegel, a neuroscientist, studied that we do this by Observing, Witnessing, and Narrating (OWNing). That process is organized into a linear time format so we can make sense of it via Others and the Self (OATS). As internal narratives form they get lodged in the Default Mode Network, a region of the brain that resonates on fMRIs. Here it gets reinforced, often with embellishments, most of which become our truth regardless of factual accuracy. 

That could present as a myriad of possibilities: maladapted coping mechanisms (like low impulse control) and/or the sort of thinking distortions (like all-or-nothing thinking) and negative core beliefs. This confluence mirrors Tolstoy’s quote about families: “Happy families are all alike; every unhappy family is unhappy in its own way.” 

But what is happiness? One of many emotions. And what is an emotion? To Siegel, emotions are the value-appraising process that informs cognition, which is part of information processing, or the way energy symbolizes something other than itself, and is felt inside the body (intuition), sensed in others, and extends beyond with aid of devices. As we sense things in others, we get signals from the body that give us a “feeling of what happens.” 

Lisa Feldman Barrett, another neuroscientist, has been advancing a theory of constructed emotion, which extends from Siegels to suggest that as our bodies navigate the energy transfer of the world, the brain works to balance our oxygen, glucose, blood pressure, etc, and the mind (being the active participant it is) categorizes these experiences so that the brain can balance the body and keep it safe. It does this through Introspection, which is our brain’s awareness of itself:

“Through prediction and correction, your brain continually creates and revises your mental model of the world. It is a huge, ongoing simulation that constructs everything you perceive while determining how you act. But predictions are not always correct, when compared to sensory input, and the brain must make adjustments…Prediction errors aren’t problems. They are a normal part of the operating instructions of your brain as it takes in sensory input. Without prediction error, life would be a yawning bore. Nothing would be surprising or novel, and therefore your brain would never learn anything new.”

So your mind uses emotions to help your brain make predictions on how to regulate its body balance, which is what Barrett terms the balance of hormones and chemicals in the body. From a story perspective, imagine a movie you’ve seen that’s cliched. You end up predicting the outcome before it happens. That results in a stasis in your body. You’re literally unmoved. But if the story surprises you and subverts the expectation, then you feel moved, whether that’s scared, awed, or amused. A new thing has been learned and the brain’s concept department has been expanded. David Brooks recently opined on how the loss of interest in humanities corresponds with the decline in civility. What I took away from Brooks' piece was that the humanities expand our mental models and calm us down by connecting us. Barrett echoes this: “There are many ways to gain new concepts: taking trips (even a walk in the woods), reading a book, watching movies, trying unfamiliar foods. Be a collector of experiences.”

Barrett and her colleagues arrived at their theory by working on multiple continents, discovering that emotions are culturally dependent. Germans feel schadenfreude, a pleasure at another person’s misfortune, which didn’t exist in the U.S. until recently. Once explained, one can experience it, too. Barrett wisely doesn’t contend our feelings or concepts aren’t real. Cash may be a piece of paper but our collected feelings about it engender value. Buddhists realized this centuries ago. Contemporary Buddhist Alan Watts says in a meditation that “it’s your ears turning vibration into sound, and your eyes turning light into color, and in that way you are making the world.” The ownership of meaning is the bedrock of Cognitive Theory. How we think dictates how we feel. In CBT, we reframe and modify thoughts; in ACT, we detach so we can see we aren’t our thoughts, we think them. 

Cognitive behavioral approaches work because of a mindful direction of energy, aka, consciousness, which is made possible because of neuroplasticity, the adaptive feature of the brain, which has been studied to reveal how our brain’s wiring carves new neural pathways. This is also called learning. To prime our brains for greater flexibility, Siegel came up with the Mindsight Seven (reflection, sleep, movement, focus-energy, play, connection, and downtime). Barrett also contends sleep, diet and exercise are important in improving our mental wellbeing (see my blog on that). Diet, sleep, and movement help manage body balance, which Siegel refers to as the Window of Tolerance. Without them, our thresholds for stress and despair narrow. I focus on sleep because of this, and I feel our the mental health field overlooks it alongside exercise and diet.  

Most mental health pro’s will point to studies showing that the therapeutic relationship is the number one reason folks stay in therapy. That fact is backed by neuroscience because human connection is the primary way we learn to self-regulate, and we learn via modeling because of mirror neurons, which has been observed by neuroscientists using fMRI. Human connection is, after all, part of the Mindsight Seven, and helps, as Siegel says, stimulate neural activation and growth (SNAG...the dude loves his acronyms). 


Siegel notes that if we don’t have access to people, connecting to nature and even art can help us feel a similar bond. But nature also has healing properties as evidenced by studies. In the 1980s, as more of Japan began living and working long hours in cities, suicides climbed. Japanese therapists wondered if taking folks to nature could help, developing shinrin-yoku (forest bathing) to help soothe folks with mental illnesses. They tracked people’s subjective experience alongside biometrics and found that time spend in nature led to higher quality sleep that following night, lower stress, reduced blood pressure, lower blood-sugar levels, a higher T-cell and white blood cell count, and improved mood, energy, concentration, and memory.

Just as our bodies need a balance, so too does mother nature. In The Serengeti Rules, biologist Sean Carroll details the stories of the biologists who drew the links between cellular balance and the grander, ecosystem balance. A system is diseased when it’s out of balance.  For instance, we need cholesterol to make tissue, but an imbalance of cholesterol in your body can cause your arteries to clog, leading to heart attack or stroke. Algae is needed in lakes, but too much and it depletes the oxygen and all else dies. From a mental health perspective, depression could be seen as imbalance in neurochemicals that present as an imbalance (or inflexibility) in cognition and perception. That imbalance can form as the result of insomnia, changes in your environment, or the maladapted responses to early childhood. Consider that most consumption is impulsive, a way to ward off uncomfortable emotions like boredom. The quick fix provides dopamine and we feel better for a minute, but that purchase requires industries to mine and make plastics, and all of that puts a burden on the earth. Our imbalances create larger imbalances, and like the algae bloom in a lake, create unhealthy systems. 

I focus on the earth because I have been fascinated by it since I was little boy playing in the woods behind my home in rural North Carolina. I believe many of us struggle to see its decline, yet we also struggle against urges to consume in ways that endanger a vital resource. I don’t have an answer to that riddle, but would like to work with others to find the balance that brings greater harmony to our world. As a social worker who endeavors to improve mental and physical health, thinking macro-level is important because we need to move folks away from the cliff. Creating safer, more affordable housing options will help improve sleep. Redirecting farming subsidies towards a more plant-based diet could improve health. Providing better access to green spaces and time to go there will make people less stressed and happier. All of these will improve many people's baseline.

What would our world look like if we tried to find a better balance with our environment? How would our health look? What would our day-to-day be like? Poet-farmer Wendell Berry is a good guide for how to find harmony with the world (see my post), but Berry is an ascetic; he plows without tractors and endures difficulties us average folks, weened on DoorDash, would probably die trying to manage. However, as a frame of reference, I see the balance of nature and the allure of healthy ecosystems as a rallying cry for public service and a touchpoint for clinical work, too. Looking for connections and ways to find harmony is as much a spiritual pursuit as a professional one. Here, I consider the words of African American biologist Ernest Everett Just, who said, "We feel the beauty of Nature because we are part of Nature and because we know that however much in our separate domains we abstract from the unity of Nature, this unity remains." Thus, we should hold nature with reverence, gazing upon it with the sort of wonder one would see in the majesty of a cathedral. Or, as Rubin would suggest, looking at it like a beginner. 


Bringing these different disciplines together is one of the ways I plan to infuse my work and my life with knowledge. I like stories because they showcase our capacity to change. Stories are meant to be shared because we are social animals and the transfer of our energy between each other is how we learn, connect, and thrive. Energy isn’t just balance between people and within us via body balance, it’s also how we find harmony with our earthly home. We are of the earth and it is enough. Finding harmony with it is part of my life’s work, it’s where I find meaning… or at least until I learn otherwise. 

Category :

Mental Health